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. 2025 Feb 13;41(1):e70018.
doi: 10.1002/joa3.70018. eCollection 2025 Feb.

Managing a ventricular tachycardia storm: Looking beyond the horizon

Sanjai Pattu Valappil  1 , Abhinav B Anand  2 , Prashanthan Sanders  3 , Ramana Murugadass  1
Affiliations

Managing a ventricular tachycardia storm: Looking beyond the horizon

Sanjai Pattu Valappil et al. J Arrhythm. .

Abstract

The case highlights the possibility of nonischemic cardiomyopathy in patients with coronary artery disease and the complex nature of the isthmus with multiple entry and exit points. A combination of multiple strategies, that is, unipolar mapping, isochronal late activation mapping during sinus rhythm, and positioning of a multielectrode catheter at the putative isthmus during VT induction in the case of hemodynamically unstable VT, was used to achieve a successful outcome.

Keywords: VT isthmus; ablation; epicardial; multielectrode catheter; reentry.

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Conflict of interest statement

The authors have no conflict of interest to declare. All coauthors meet the criteria for authorship and appropriate acknowledgments are made in the manuscript. In case of any errors in the data, the journal will be informed. We hereby transfer, assign, or otherwise convey all copyright ownership, including any and all rights incidental thereto, exclusively to the journal in the event that such work is published by the journal.

Figures

FIGURE 1
FIGURE 1
Twelve‐lead (12‐lead) electrocardiograms during sinus rhythm and ventricular tachycardia (upper and lower panel).
FIGURE 2
FIGURE 2
LV endocardial bipolar map (left) and unipolar map (right). Lower panel shows limited endocardial activation mapping because of hemodynamic instability, which shows a wide area of early activation without any mid‐diastolic activity.
FIGURE 3
FIGURE 3
(A) Epicardial voltage map (upper panel). (B) Epicardial ILAM and presence of late potentials (lower panel).
FIGURE 4
FIGURE 4
Induction of ventricular tachycardia from RV pacing. The multielectrode is placed in the region of epicardial ILAM. The green arrow marks the local conduction block in the isthmus inducing ventricular tachycardia; the first beat is narrower than the clinical VT and has another endocardial exit. The postulated mechanism of the tachycardia is explained in the next figure.
FIGURE 5
FIGURE 5
The upper panel shows localized conduction block followed by localized reentry. Magnified view of the local EGM and putative mechanism of induction of tachycardia (green asterisk and brown circle represent the reversal of activation during ongoing VT after induction, magnified from Figure 3).
See this image and copyright information in PMC

References

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